title: Recent health insurance trends for US families: children gain while parents lose.
abstract: In the past decade, political and economic changes in the United States (US) have affected health insurance coverage for children and their parents. Most likely these policies have differentially affected coverage patterns for children (versus parents) and for low-income (versus high-income) families. We aimed to examine--qualitatively and quantitatively--the impact of changing health insurance coverage on US families. Primary data from interviews with Oregon families (2008-2010) were analyzed using an iterative process. Qualitative findings guided quantitative analyses of secondary data from the nationally-representative Medical Expenditure Panel Survey (MEPS) (1998-2009); we used Joinpoint Regression to assess average annual percent changes (AAPC) in health insurance trends, examining child and parent status and type of coverage stratified by income. Interviewees reported that although children gained coverage, parents lost coverage. MEPS analyses confirmed this trend; the percentage of children uninsured all year decreased from 9.6 % in 1998 to 6.1 % in 2009; AAPC = -3.1 % (95 % confidence interval [CI] from -5.1 to -1.0), while the percentage of parents uninsured all year rose from 13.6 % in 1998 to 17.1 % in 2009, AAPC = 2.7 % (95 % CI 1.8-3.7). Low-income families experienced the most significant changes in coverage. Between 1998 and 2009, as US children gained health insurance, their parents lost coverage. Children's health is adversely affected when parents are uninsured. Investigation beyond children's coverage rates is needed to understand how health insurance policies and changing health insurance coverage trends are impacting children's health.
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA, devoej@ohsu.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
authors.forename: Carrie J
authors.initials: CJ
authors.lastname: Tillotson
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Wallace
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D018166:Health Care Reform; D005102:Health Expenditures; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000639:trends*; D007348:Insurance, Health / Q000191:economics / Q000639:trends*; D007407:Interviews as Topic; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D009313:National Health Programs / Q000458:organization & administration; D020380:Needs Assessment; D009922:Oregon; D010287:Parent-Child Relations; D010290:Parents; D012959:Socioeconomic Factors; D014481:United States